The Technical Assistance and Information Exchange (TAIEX), which is a special sector of the European Commission Directorate-General for Enlargement, in co-operation with Ministry of Health, Republic of Serbia on behalf of the South-Eastern Europe Health Network Regional Health Development Center on Accreditation and Continuous Quality Improvement and Regional Health Development Center on Blood Products and Safety, Oradea, Romania, organized the 3-day multi-country Workshop on Increasing Blood Availability and Providing the Highest Donor and Patient Safety in Transfusion Therapy in Emergency Special Circumstances in Bucharest, Romania on July 07 – 09, 2014.

The main aim of the workshop was:

• To review the application of the EC Directive 2002/98/EC of the European Parliament and of the Council of 27 January 2003 setting standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components and amending Directive: current status, progress in implementing, achievements and challenges of the SEE countries members of the SEE Health Network; cross learning from the experience of the EU Member States, the counties of the SEEHN itself and other neighboring countries;

• To increase awareness and political/institutional capacities, among SEEHN member states, about the harmonized ways for getting the Highest Patient Safety in Transfusion Therapy in Emergency Special Circumstances (natural disasters as floods, earthquakes, massive traffic accidences) at both levels:

- pre-hospital (blood centers specialists) and

- hospital (clinicians), based on Bioethical principles;

• To apply in a complementary and logical manner the EU directives 2002/98/EC, and Council recommendation 2009 on Patient Safety.

At the workshop the following key experts in the field of transfusion and blood safety presented their work: Rossen Georgiev, Bulgaria; Imad Sandid, France; Ludo Meyers, Belgium; Polonca Mali, Slovenia and Corina Posea, Romania. Special attention was given to providing the highest donor and patient safety in transfusion therapy in emergency circumstances. Web-based Rapid Alert system for Blood and Blood Components (RAB) that allows EU countries to exchange information so that cross-border incidents are prevented or contained and immediate measures can be taken to ensure the safety of patients, was also presented.

Besides the above mentioned experts, the workshop was attended by representatives of Albania, both Federation of Bosnia and Herzegovina and Republic of Srpska, Croatia, Israel, Moldova, Macedonia, Montenegro, Serbia, Romania, Kosovo and Turkey; and who represented their experiences in the field of blood safety and transfusion therapy, legislation and developments in this area. Republic of Srpska was represented by Andreja Subotic-Popovic, MD, RS Ministry of Health and Social Welfare and Vesna Vujic-Aleksic, MD, RS Agency for Certification, Accreditation and Health Care Quality Improvement.

Participation in this event and sharing of experiences and ideas with participants from other countries for our colleagues carries a great value, especially for the activities undertaken by the Agency to further improve our health care system.

With great pleasure we are announcing that Health Care Institution Family medicine team „Dr Sneza“ from Ugljevik has successfully completed a certification procedure and gained a status of certified health care institution, thus confirmed that it fulfilled required safety standards in providing health care.

Auditors of the Agency for Certification, Accreditation and Health Care Quality Improvement of the Republic of Srpska conducted the external audit of the HCI FMT “Dr Sneza” on December 24, 2013 in conformance with the Certification standards for family medicine teams and the Rulebook on certification procedure of health care institutions and content of the registry of certified health care institutions. A RS Ministry of Health and Social Welfare’ decision on awarding a certification status to this family medicine team was brought on January 30, 2014.

This health care institution is the first privately owned specialist clinic to complete certification procedure and fulfil the standards’ requirement regarding, among other things, continuous education of employees, following appropriate procedures related to health care safety, proper keeping of medical documentation, intrahospital infections control, proper disposal of medical waste and adverse events reporting.

The RS Agency for Certification, Accreditation and Health Care Quality Improvement would like to thank members of FMT “Dr Sneza” on all effort they made in order to achieve these result and great cooperation emerged during the certification process of this clinic, which we hope will be continued in the future through activities on quality improvement of health care services they provide to their patients.

As a part of the B&H Mental Health Project’s goal „Promotion of the Accreditation Process of the Community Mental Health Centres (CMHC) in Republic of Srpska“ at the end of 2013, Agency for Certification, Accreditation and Health Care Quality Improvement completed accreditation process of another two Mental Health Care Centres in Republic of Srpska.

CMHC of PHC Centre Derventa and CMHC of PHC Centre Zvornik were accredited as last two out of ten planned. External audits were organized on November 27, 2013 in CMHC Derventa and December 25, 2013 in CMHC Zvornik, preceded by thorough preparations in these centres and pre-auditing visits organized in July 2013 in CMHC Derventa and in November 2013 in CMHC Zvornik. The auditors’ accreditation reports confirmed fulfilment of all necessary conditions so the Agency’s accreditation commission, with great pleasure, awarded the accreditation status to CMHC teams of the mentioned PHC centres.

The Agency uses this opportunity to thank the directors of PHC centres, head of CMHC Derventa dr Djuradj Petrovic and head of CMHC Zvornik dr Irena Janjic, and all employees in these CMHCs for recognizing the importance of accreditation in health care quality system as well as for initiative and efforts invested in successful realization the accreditation process. We would also like to thank our external assessors for their cooperation and help.

During the realisation of the first phase of the Mental Health Project in B&H the Agency accredited ten CMHC in Republic of Srpska, thus fulfilling the plan provided in activities defined with the MHP. It is expected to continue this cooperation in the future with goals, which will include, among others, continuation of CMHC accreditation.

Following <link record:tt_news:165>the first completed health care institution certification process in December 2012, RS Agency for Certification, Accreditation and Health Care Quality Improvement during 2013 intensified its activities in the field of certification of health care institutions.

Besides developing documents necessary to conduct certification procedure, ASKVA organised training for external assessors for assessing in conformance with the pharmacies’ certification standards (in February in Banja Luka and in September in Gradiska) as well as training for external assessors for assessing in conformance with the certification standards for primary health care centres and hospitals (in February in Gradiska). The training was successfully completed by 55 external assessors. Contacts with family medicine teams, specialists’ clinics and centres were ramped up and two presentations regarding preparations for certification procedure were held to their representatives (in June in Banja Luka and in December in Teslic). Experiences gained in certification procedure of pharmacies were presented at the XIV Pharmacists Symposium in Bijeljina.

In the following table we present activities of completed certification procedures of health care institutions, with dates on pre-assessing and external assessing visits.

The Technical Assistance and Information Exchange (TAIEX), which is a special sector of the European Commission Directorate-General for Enlargement, in cooperation with the Ministry of Health of Republic of Serbia, on behalf of the South-East Europe Health Network (SEEHN) and Regional Health Development Centre for Accreditation and Continuous Health Care Quality Improvement, organised the 2-day Workshop on Clinical Risk Management and Adverse Event Management in Belgrade on December 16-17, 2013.

The workshop was organized as a part of activities related to the EU Council Recommendation on patient safety: including the prevention and control of health care associated infections (2009/C 151/01), brought on 9 June 2009 in Luxembourg. The Council of the European Union recommends that SEEHN member states should set up, maintain or improve comprehensive reporting and learning systems so that the extent and causes of adverse events can be captured in order to develop efficient solutions and interventions. Patient safety should be embedded in the education and training of healthcare workers, as the providers of care. Impact of patient safety on clinical outcomes among SEEHN member states and a need to identify common challenges and actions for mutual recognition of patient safety among the SEEHN member states and harmonizing with EU requirements was discussed as well.

At the workshop the following key experts presented their work: Pia Knudsen, of National Agency for Patients’ Rights and Complaints, Denmark; Lucia Guidotti, of Ministry of Health, Italy; Adriana Galan, of National Institute of Public Health, Romania; Hanne Tønnesen, of Clinical Health Promotion Centre (WHOCC) Frederiksberg Hospital, Denmark; Yvonne Tuitert, of Ministry of Health, Welfare and Sport, Netherlands, and Maria Ruseva, Freelance International Expert, Member of the SEE Health Network, Denmark.

Besides the above mentioned experts, the workshop was attended by representatives of Moldova, Israel, Albania, Federation of Bosnia and Herzegovina, Montenegro, Macedonia, Romania, Croatia and Serbia who represented their experiences in the field of patient safety, legislation and developments in this area. Republic of Srpska was represented by director of RS Agency for Certification, Accreditation and Health Care Quality Improvement Sinisa Stevic MD and head of Certification Sector Vesna Vujic-Aleksic MD. Dr Stevic moderated the second day’s session which included themes on clinical risk management.

The Agency’s team presented our experiences in the field of clinical risk management and adverse event management, areas covered by the certification standards for health care institutions.

This workshop represents one of the first activities to achieve goals built in the South East Europe 2020 Strategy that sets for the first time health care as one of foundation for inclusive growth. One of the four objectives defined in this Strategy is introduction of measures for improvement of public health with a focus on poor and marginalized groups, by strengthening capacity for delivering high quality services and health promotion.

Participation in this event and sharing of experiences ad ideas with participants from other countries for our colleagues carries a great value, especially for the activities undertaken by the Agency to further improve our health care system.

The RS Agency for Certification, Accreditation and Health Care Quality Improvement continues with activities undertaken to achieve the project goal „Promotion of the Accreditation Process of the Community Mental Health Centres (CMHC) in Republic of Srpska“ in accordance with cooperation with the Mental Health Project. In the last period, we have conducted accreditation process of community mental health centres of PHC centres Pale and Banja Luka.

After thorough preparations in these centres and great efforts that teams’ member invested, external assessment of accreditation process were organized on October 28 in CMHC Pale and on November 7, 2013 in CMHC Banja Luka; and registered assessors of the Agency, with the use of standard accreditation methods, verified fulfilment of all necessary conditions so the Agency’s accreditation commission, in accordance with the assessors’ reports, with great pleasure awarded the accreditation status to CMHC teams of the mentioned PHC centres.

The Agency uses this opportunity to thank the directors of PHC centres, head of CMHC Pale dr Aleksandra Garic and head of CMHC Banja Luka dr Ranka Kalinic, and all employees in these CMHCs for recognizing the importance of accreditation in health care quality system as well as for initiative and efforts invested in successful realization the accreditation process. We would also like to thank our external assessors for their cooperation and help.

So far, under this Project, the Agency awarded eight Community Mental Health Centres in Republic of Srpska with accreditation status and two more are to be accredited by the end of the project activities.

RS Agency for Certification, Accreditation and Health Care Quality Improvement, in the period of September 24-25, 2013 in Bijeljina, organised the two-day Course for assessors for external assessment in accordance with the certification standards for pharmacies. The course attendees were pharmacists from the Bijeljina-Doboj area.

The practical part of the training was organised on the second day at three pharmacies in Bijeljina. We would like to express our gratitude to the management and all employees of these institutions for their hospitality and assistance with which we were able to successfully, in high quality and to the great satisfaction of the participants, conduct the practical part.

The trainees showed the great interest for all subjects and actively and with dedication participated in all activities organised during the course. At the end of the course, all of them were awarded with certificates on completion the course on assessment of quality and safety systems in health care so they all became registered external assessors for health care institutions’ certification procedure.

During the three-day visit, dr Charles D Shaw conducted a series of lectures on subject “Deepening our understanding of quality improvement in Europe (DuQuE Project)” for representatives of health care institutions and other professionals of all health care levels in the Republic of Srpska, about the European project aiming to study effectiveness of quality improvement system in hospitals around Europe and to present different experiences in the field of safety and quality improvement in health care.

Along with the guest, the lecturers were Gordan Jelic, MD, Mr Sc, director of the RS Ministry’s of Health and Social Welfare Project Coordination Unit; Radomir Boskovic, of “Bonex Inzenjering”, and Sinisa Stevic, MD, Mr Sc, director of the RS Agency for Certification, Accreditation and Health Care Quality Improvement, who presented already completed previous activities in the field of health care quality and safety improvement in RS as well as future steps in development of the system.

During his stay in Republika Srpska, dr Charles Shaw participated in a pre-assessment certification visit to University Hospital Foca, along with ASKVA’s assessing team, where he had an opportunity to learn more about external certification assessment and certification program in Republika Srpska.

By the RS Ministry of Health and Social Welfare’s decision, brought on September 11, 2013, the certification was confirmed for three pharmacies operating within the HCI Pharmacies “B Pharm”, “Jana”, “B Pharm #22” and “B Pharm #7”, and they were all awarded with certification status.

Auditors of the Agency for Certification, Accreditation and Health Care Quality Improvement of the Republic of Srpska conducted the external audit of these pharmacies on July 27, 2013 by the Certification standards for pharmacies and in accordance with the Rulebook on certification procedure of health care institutions and content of the registry of certified health care institutions.

These three pharmacies are the only pharmacies in the Republic of Srpska with a valid accreditation status at ASKVA. The external accreditation audit was conducted in August 2012 in pharmacy “Jana” and in November 2012 in pharmacies “B Pharm #22” and “B Pharm #7”.

On this occasion, the RS Agency for Certification, Accreditation and Health Care Quality Improvement would like to thank management and all employees of afore mentioned pharmacies on recognizing the importance of certification and accreditation process in safety and quality system in health care as well as on all effort they made in order to achieve these results. We are hoping this success shall serve as a stimulus for other pharmacies operating within the Health Care Institution “B Pharm” to join safety and quality improvement process in health care.

External assessment in the first re-accreditation process of CMHC of the Brcko District organized on July 3^rd, 2013 and led by registered assessors who are mental health professionals along with ASKVA’s employees, confirmed commitment and engagement of all team members of this centre to mental health care quality improvement through accreditation program.  The Agency’s Commission afterwards, based on the assessors’ report, and with great pleasure awarded the accreditation status to the team of this centre.

The Agency uses this opportunity to thank the acting director of newly established Public health institution Health care centre of the Brcko District Nihad Sibonjic MD, head of CMHC Zlata Papric MD and all employees in CMHC for recognizing the importance of accreditation in health care quality system as well as for initiative and efforts invested in successful realization of CMHC re-accreditation process.

In order to enable health care institutions to get prepared for the certification process, ASKVA shall on its web page give answers to questions related to the certification standards and provide clarification of standards' requirement.

Questions should be sent via email <link>sertifikacija@askva.org.

Answers to your questions will be available as soon as possible on <link>this web page.

The visit was organized to improve cooperation between these three agencies, which was raised to formal level through establishment of the South-Eastern European Health Care Network and the Regional Centre for Quality and Accreditation, as well as through the 2011 Memorandum of Understanding between AZUS and ASKVA.

On the first day of the visit, AZUS presented its accreditation program and achieved results. Subsequently, a visit to General Hospital “DJordje Joanovic” in Zrenjanin was organized, and Gordana Kozlovacki MD, director of the hospital, presented their work and achieved quality improvement in providing health services to patients from the perspective of an accredited health care institution.

On the second day of the visit, guests from AKAZ and ASKVA presented their work and accreditation programs to their hosts. Afterword, AZUS employees introduced a new accreditation software which will be in use in September 2013.

At the end of a very successful working visit, the agencies’ directors jointly concluded that had, through learning the way of work of all agencies, efficiently recognized similarities and differences in organization and accreditation programs which could be used as a good basis for continuation of information and experience sharing and harmonization of the programs in order to simplify monitoring of its effects on safety and quality improvement in health care. Presentation of the accreditation program of the Zrenjanin hospital as an example of good practice in accreditation has confirmed that accreditation is a tool for continuous health care quality improvement that brings visible results. They have also decided on further cooperation of the agencies through documents, standards and external assessors exchange, organization of annual meetings of employees hosted by different agency as well as through work on jointly created projects relevant to the agencies’ scope of work.

Vesna Vujic-Aleksic MD of ASKVA, with the presentation “Certification as an element of health care improvement in the Republic of Srpska”, introduced the certification process and standards, certification procedure of medical institutions and its goals and importance. Rada Amidzic Msc. Ph. of the Association of Pharmacists of the Republic of Srpska, with the presentation “Experience and role of the RS Association of Pharmacists in preparation process of certification of pharmacies”, described the way the RS Association of Pharmacists gave its contribution to preparation of pharmacies for the certification process through design of necessary documentation as well as education of its members.

The final conclusion at the end of the work was that the RS Association of Medical Doctors in Private Practice would coordinate activities on preparations of private health care institutions for the certification process, modeled on the successful work of the RS Association of Pharmacists.

Continuation of the cooperation of the RS Agency for Certification, Accreditation and Health Care Quality Improvement with the Association XY on the Mental Health Project is realised through activities undertaken to achieve the project goal „Promotion of the Accreditation Process of the Community Mental Health Centres (CMHC) in Republic of Srpska“.

As a part of these activities, external assessment in the accreditation process of CMHC Teslic was organised on Wednesday May 29, 2013. The registered assessors of the Agency through external assessment on the spot, with the use of standard accreditation methods, verified fulfilment of all necessary conditions. In accordance with the assessment report the Agency’s accreditation commission with great pleasure awarded the accreditation status to CMHC Teslic.

CMHC Teslic is the sixth CMHC team to be accredited as a part of the Mental Health Project in Republic of Srpska. The Agency uses this opportunity to thank management of Primary Health Care Centre Teslic and all employees in CMHC with its head Bosko DJuric MD for recognizing the importance of accreditation in health care quality system as well as for initiative and efforts invested in successful realization of CMHC Teslic accreditation process.

Auditors of the Agency for Certification, Accreditation and Health Care Quality Improvement of the Republic of Srpska conducted the external audit of the HCI Pharmacies Biljana on May 22, 2013 by the Certification standards for pharmacies and in accordance with the Rulebook on certification procedure of health care institutions and content of the registry of certified health care institutions.

By the RS Ministry of Health and Social Welfare’s decision, brought on June 12, 2013, the certification was confirmed for all three pharmacies operating with the HCI Pharmacies “Biljana” and they were all awarded with certification status.

On this occasion, the RS Agency for Certification, Accreditation and Health Care Quality Improvement would like to thank management and all employees of HCI Pharmacies „Biljana“ on recognizing the importance of certification process in the health care safety system as well as on all effort they made in order to achieve these results and becoming the first three certified pharmacies in the Republic of Srpska.

The Workshop was international, and along with the AKAZ director Ahmed Novo MD and the ASKVA director Sinisa Stevic MD with associates Vesna Vujic-Aleksic MD and Jagoda Beric, participants of the Workshop were representatives of associations and agencies for quality and safety in healthcare from Denmark, Poland, United Kingdom, Czech Republic, Monte Negro and host Croatia.

The first day of the Workshop brought subjects on performance measurement in healthcare with presentation of the Croatian results of the WHO PATH project (World Health Organisation Performance measurement tools for hospitals). On the second day the participants had an opportunity to learn about achievements in patient safety and safety culture. The ESQH Annual Workshop was, as always, the excellent opportunity for regional and European health professionals to share experiences and start a cooperation which would lead to healthcare quality and safety improvement.

The Agreement was signed between Sinisa Stevic MD, Mr Sc, director of ASKVA, Ahmed Novo MD, director of the Agency for Quality and Accreditation in Health Care of Federation of B&H, Valérie Falbriard of the Coordination of the Swiss Cantons of Bern, Fribourg, Geneva and Jura, and Thomas Moser of the External Relation Service, Strategic committee.

The signatories have agreed on technical solutions defined in the Agreement represent a roadmap for “quick wins” and contribute to the fulfilment of the “long term objectives” and are based on following documents: Mental Health Project in Bosnia and Herzegovina, Module 2: Study, system analysis and scenarios for further initiatives (by L. Bürki); Workshop-paper: Business model canvas and Workshop-paper: Roadmap.

Implementation of activities on the second phase of the B&H Mental Health should start in next year.

Course for assessors for external assessment in accordance with the certification standards for PHC and hospitals

In the period of February 14-16, 2013 ASKVA organised the three-day Course for assessors for external assessment in accordance with the certification standards for primary health care centres and hospitals in the General Hospital Gradiska. The course was created using the methodology and program of the earlier held course for external certification assessors and was led by Sinisa Stevic MD and Daniela DJeric MSc, of ASKVA, and Radomir Boskovic, of consulting company „Bonex inzenjering“. The course participants, employees of health care institutions from Gradiska, Prijedor, Novi Grad and Banja Luka, had the opportunity to learn in detail all aspects of external assessment, certification, certification standards and safety system.

The practical part of the training was organised the third day at the PHC Gradiska nad GH Gradiska. So, we would like to express our gratitude to the management and all employees of these institutions for their hospitality; with their assistance we were able to successfully conduct the practical part, to the great satisfaction of the participants.

The trainees showed the great interest for all subjects and actively and with dedication participated in all activities organised during the course. At the end of the course, all of them were awarded with certificates on completion the course on assessment of quality and safety systems in health care so they all became registered external assessors for health care institutions’ certification procedure.

Course for assessors for external assessment in accordance with the certification standards for pharmacies

The two-day course for assessors for external assessment in accordance with the certification standards for pharmacies was held on February 20 and 21, 2013 in Banja Luka for representatives of pharmacies of the Banja Luka region. The education had been created and conducted in accordance with the methodology and program of earlier held courses for assessors for certification assessment of health care institutions. The educators were Daniela DJeric MSc and Vesna Vujic-Aleksic MD of ASKVA. 

The participants of this course, as well as of others, with active involvement, successfully mastered presented material and adopted knowledge and skills necessary for acquiring the title of external assessor for certification procedure of pharmacies, so, at the and of course, they were awarded with certificates on completion the course on assessment of quality and safety systems in health care.

Auditors of the Agency for Certification, Accreditation and Health Care Quality Improvement of the Republic of Srpska conducted the external audit of the PHC Centre Bijeljina at the beginning of December, 2012 according to the Certification standards for primary health care institution and in accordance with the Rulebook on certification procedure of health care institutions and content of the registry of certified health care institutions.

By the RS Ministry of Health and Social Welfare’s decision, brought on December 17, 2012, the certification was confirmed and PHC Centre Bijeljina was awarded with certification status. The ceremonial delivery of the Decision on certification was arranged on December 21, 2012 at the reception organized by the PHC Centre Bijeljina to present their excellent business results.

On this occasion, the RS Agency for Certification, Accreditation and Health Care Quality Improvement would like to thank management and all employees of the PHC Centre Bijeljina, managed by its director Zlatko Maksimovic MD, on recognizing the importance of certification process in the health care safety system, on all effort they made in order to achieve these results and becoming the first certified health care institution in the Republic of Srpska, as well as on previous cooperation achieved through accreditation programs of family medicine teams, Mental Health Care Centre and Community Based Rehabilitation Centre of the PHC Centre Bijeljina; with a wish to successfully continue business cooperation.

Continuation of the cooperation of the RS Agency for Certification, Accreditation and Health Care Quality Improvement with the Association XY on the Mental Health Project is realised through activities undertaken to achieve the project goal „Promotion of the Accreditation Process of the Community Mental Health Centres (CMHC) in Republic of Srpska“. As a part of these activities, during November 2012, accreditation external assessments of CMHC in four RS Public Health Care Centres were organized. 

Members of teams in CMHC Ugljevik, Novi Grad, Doboj and Srbac have in the last period made great efforts to prepare themselves in the short time for external assessment. The registered assessors of the Agency, health professionals employed in CMHC Gradiska, Prijedor, Doboj, Novi Grad, Srbac, Zvornik, Pale and Brcko, through external assessment on the spot on November 12 in CMHC Ugljevik, November 15 in CMHC Novi Grad, November 20 in Doboj and November 29, 2012 in CMHC Srbac, with the use of standard accreditation methods, verified fulfilment of all necessary conditions so the Agency’s accreditation commission, in accordance with the assessors’ reports, with great pleasure awarded the accreditation status to CMHC teams of the mentioned PHC centres. 

The Agency uses this opportunity to thank the directors of PHC centres, head of CMHC Ugljevik dr Vasika Draskovic, head of CMHC Novi Grad dr Irena Marin, head of CMHC Doboj dr Sladjana Onrust and head of CMHC Srbac dr Aleksandra Gromilic and all employees in CMHCs for recognizing the importance of accreditation in health care quality system as well as for initiative and efforts invested in successful realization of accreditation process.

So far, under this Project, the Agency awarded five Community Mental Health Centres in Republic of Srpska with accreditation status and five more are to be accredited by the end of the project activities.

The conference was attended by managers of the primary health care centres, representatives of the RS Public Health Institute and Health Insurance Fund, as well as heads of family medicine departments and quality coordinators of PHC centres.

Dr Milan Latinovic, RS Deputy Minister of Health and Social Welfare and Mr Sc. dr med. Gordan Jelic, head of RS MHSW PCU and Slobodan Corsovic, general manager of consultancy company “Bonex inzenjering” addressed the attendees at the beginning of the conference and presented the previous work on implementing different activities included in the comprehensive Health Sector Enhancement Project. Afterwards, Mr Sc. dr med. Sinisa Stevic, director of ASKVA presented the three-component project and its goals, contractors, duration, participants and expected outcomes. The implementation of the project activities will last until end of 2014 and will include accreditation of 200 family medicine teams across the Republic of Srpska and certification of 20 PHC centres. The third component of the Project will set a foundation to introduce clinical management necessary to continuously improve the health care quality through introduction of clinical pathways in primary health care and monitoring of quality indicators using a software application that will data gathered from PHC centres use to calculate compliance of regulated indicators.

In the last period there were several important conferences regarding health care improvement, where representatives of the RS Agency for Certification, Accreditation and Quality Improvement in Health Care took part in and actively participated. Given that professional development and continuous improvement of knowledge and skills of the employees is the Agency’s lasting commitment, we shall keep on following the trends in the field of health care quality and safety improvement in order to experiences learned on international meeting apply in our work.

Health Conferences UK organised in London on March 21, 2012 a one-day international conference “Clinical Quality Indicators and Dashboards”. The conference was attended by head of the Agency Sinisa Stevic MD and IT specialists Jagoda Beric and Danko Jotanovic. Besides presentations of relevant British experts on importance of clinical quality indicators, the participants had an opportunity to expand their knowledge on practical use of the indicators analysed in few presented case studies from important institutions of the British health system.

The Institute for Health Protection of Republic of Slovenia invited the Agency to attend one-day workshop “Pathways in electronic form”. On behalf of the Agency, Savka Strbac MD, head of the Sector for accreditation and quality affairs, represented Republic of Srpska, and participated in the workshop held in Ljubljana on April 26, 2012. Representatives from Slovenian hospitals and other health care institutions attended the event where guest lecturer were Arjen Noordzi MD from the Netherlands, presenting “Experiences in implementing e-pathway”, and our Savka Strbac MD, presenting “Development of pathways in Republic of Srpska”.

The European Care Pathway Conference was organised in Amsterdam between May 31 and June 1, 2012 with 150 participants from 16 countries. During the two-day conference, attendees had the opportunity to learn, through numerous professional lectures and discussions, about current trends in the field of care pathways and operational management and share their experiences. The only representative from Republic of Srpska and B&H, Savka Strbac MD participated with poster presentation “Introduction of care pathways in University Hospital Banja Luka – the attitudes of health professionals”. Visit to an Amsterdam general hospital was a part of the conference program, so attendees learnt about experiences of the hospital’s 10-years use of care pathways; all of that represented great importance in sharing experiences and ideas that could be used in improving our health care system. 

Accreditation preparations, conducted during first months of this year, were successfully completed by Community Based Rehabilitation Centre Novi Grad and were positively valued and confirmed by the external accreditation survey conducted by the Agency’s registered surveyors. The external survey on the spot was organized on May, 25 2012, followed by awarding CBR centre Novi Grad with the accreditation status by the Agency’s Accreditation Commission.

Activities conducted by the management and all employees of PHC centre Novi Grad, headed by Zoran Radjenovic MD, on further realisation of accreditation process in this institution are continued through extensive preparations on accrediting Mental Health Care Centre and family medicine teams of PHC centre Novi Grad. We expect that these processes shall be successfully realised in near future to the mutual satisfaction.

Hereby, the RS Agency for Accreditation, Certification and Health Care Improvement would like to thank the entire team of PHC centre Novi Grad, firstly on their recognition of accreditation as a process of health care quality system and then, on the efforts invested by all to achieve these results as well as on their past and future work on improving quality of Republika Srpska health system. Also, we would like to show our support to employees of PHC centre’s departments who are currently conducting accreditation preparations and wish them success in achieving accreditation status.

As a part of these activities, external assessment in the accreditation process of CMHC Gradiska was organised on Tuesday July 31, 2012. The assessment was preceded with preparations that the CMHC team with head Ivana Simic MD conducted in high quality and record time. The registered assessors of the Agency, who undergone the training for CMHC accreditation assessors also within the project activities and are employed in CMHC Banja Luka and Srbac, through external assessment on the spot, with the use of standard accreditation methods, verified fulfilment of all necessary conditions. In accordance with the assessment report the Agency’s accreditation commission with great pleasure awarded the accreditation status to CMHC Gradiska. 

CMHC Gradiska is the first CMHC team to be accredited as a part of the Mental Health Project in Republic of Srpska and second in total. The Agency uses this opportunity to thank the director Bogdan Milenkovic MD of Primary Health Care Centre Gradiska and all employees in CMHC for recognizing the importance of accreditation in health care quality system as well as for initiative and efforts invested in successful realization of CMHC Gradiska accreditation process. We hope that the successful cooperation between the Agency and PHC centre and CMHC Gradiska shall be continued in the future through maintaining the accreditation status and other activities in the field of health care quality improvement as well. 

To facilitate preparations for certification procedure for pharmacies, the RS Association of Pharmacists has developed and created models of the procedures required by the certification standards for pharmacies. 

In order to introduce those procedures as well as the certification process to pharmacists, the RS Association of Pharmacists in cooperation with ASKVA, organized educations on May 12, 2012 in Banja Luka, on June 9 in Foca and June 23, 2012 in Bijeljina. Around 300 pharmacists from all over the Republic of Srpska participated in the educations.

The attended had the opportunity to listen to following lectures: 

• Mirjana Kovacevic MSc.Ph. (ASKVA): Certification of pharmacies – the procedure and goals;, 
• Rada Amidzic MSc.Ph. (RS Association of Pharmacists): Managing documentation, pharmaceutical waste, complaints and medications withdrawal from the market, 
• Vesna Todic MSc.Ph. (RS Association of Pharmacists): Managing processes in a pharmacy and protection measures, 
• Djurdjica Kopanja MSc.Ph. (RS Association of Pharmacists): Services of a pharmaceutical team and protection of patients’ confidential information.

The participants showed great interest in aforementioned subjects and were actively participated in the educations by sharing questions and practices.

The RS Ministry of Health and Social Welfare organized on Tuesday May 28, 2012 a presentation of the project „Introduction of management and quality systems in health care institutions in the Republic of Srpska; strengthening of PHC centres’ capacities and establishment of certification process of PHC centres, accreditation process of laboratories and continuous improvement of health care primary level in public sector“. Besides representatives of the RS MHSW, representatives of the RS Health Insurance Fund and the RS Public Health Institute as well, mangers of all PHC centres in Republic of Srpska participated at the presentation.

As Gordan Jelic, head of the RS MHSW’s Project Cooperation Unit, said this project was a direct support to the Law on Health Care that binds all RS health care institutions to complete formal certification procedure.

„Certification of primary level health care institutions implies that the institutions must meet standards’ requirements related to safety in providing health care as well as continuously improve health care quality. This project is a sequel of the similar project that started three years ago in the hospital sector in RS that also had a goal to establish an adequate capacity to manage safety and quality systems in health care institutions“, said Jelic. He added that with this project Republic of Srpska would be a unique instance in South-East Europe that all its health care institutions in public sector introduced health care safety and quality systems.

"Through establishing very specific mechanisms, vertical and horizontal communication and cooperation, that is coordination between all levels of health care we should work on establishing more effective and more efficient system because we shall, through establishing very demanding standards, reach the goal to avoid duplication of some services currently present in the system that lead to certain inefficiency. Our goal is, for example, that through accreditation of laboratories we reach a situation that, by raising level of trust in lab analysis, we avoid duplications of lab analysis in PHC centres and hospitals, whereby we can directly contribute system savings“, emphasized Gordan Jelic.

The RS Public Health Institute’s director Slobodan Stanic said that a role of the Institute in this meeting was to share experiences of this institution since it had started this process five years ago and was awarded with the ISO 9001 Certificate and ISO 17 025 accreditation of three laboratories, lab for physic-chemical testing, lab for microbiology and lab for testing of radionuclide.

„That standard is very similar to the 15 189 standard which will be used for accreditation of clinical laboratories. One difference is in uniqueness of a sample and the other is that there is a medical doctor responsible for quality of performed service and who evaluates quality of service provided in lab sector“, said Stanic. He emphasized that one accredited and ISO certified institution would not make a change until all system has started the process, whereby the main goal would be to reach uniformity and standardization of services so they are performed the same way in small and large ambiences. Thereby, effectiveness and efficiency of the system would be achieved as well as savings, and patients’ welfare would be ensured.

Radomir Boskovic, technical manager of Belgrade „Boneks inzenjering“ that does technical realization of the project, said that the project was very complex and consisted of seven components.

„Besides certification of PHC centres, an important component is one related to linkage of primary with secondary health care level which should lead into shortening of patients’ paths through the health care system and better communication between PHC centres and hospitals. Other important component is a measurement of performed services’ quality throughout development of relevant indicator system that would show achieved quality level“, stated Boskovic. He added the project was further complicated because it would involve PHC centres of different development level, different staffing, employment and technical equipment, some of which were progressive and already accredited and some that did not started the processes.

„Having in mind all of this, we should, as our first project activity, do survey of current situation to get a detailed analysis of how to methodologically start realization of such complex project that includes absolutely all primary and secondary health care institutions. Additional benefit of this project is an education of some number of local consultants who shall, even after the project’s completion, independently continue developing the health care system”, said Boskovic. He added that implementation of the project would last three years.

During the presentation of the project, managers of PHC centres were given the “Accreditation Guide for PHC centres” that can be downloaded here.

The Rulebook can be downloaded here. 

The first series of seminars with subject “The Importance and Role of Mental Health Centres within DZ” was organised in December 2010 in three regional centres (Istocno Sarajevo, Teslic and Banja Luka) with participation of representatives of mental health centres, primary health centres, social welfare centres and psychiatric clinics. The second series of seminars, that gathered the same participants, was organised in June 2011 in Banja Luka, Trebinje and Teslic and the third series of seminars was held in November 2011 in Laktasi and Teslic. 

The final seminar organised by the Agency will be held on Monday, 09 April 2012 at the Kardial Hotel in Teslic. The participants will have an opportunity to learn more about the past experiences in the Mental Health Project implementation and hear more information on future activities in the field of mental health improvement.

The assessment of 16 FMTs of DZ Bijeljina, conducted by qualified registered Agency’s assessors, was done in October 2011, followed by the Accreditation Commission’s positive evaluation of those FMTs and awarding them with the accreditation status. The Bijeljina Primary Health Care Centre now has 31 accredited family medicine teams.

The accreditation preparations were successfully mastered by the Bijeljina Community Based Rehabilitation Centre as well which was confirmed with the accreditation assessment organised on February 23, 2012 so the Accreditation Commission also awarded the CBR Bijeljina team with the accreditation status.  

On this occasion, the RS Agency for Certification, Accreditation and Health Care Improvement would like to thank all employees and management of DZ Bijeljina firstly on recognising the importance of accreditation in health care quality system, and then especially on efforts they made in order to achieve these results and on all previous work on health care quality improvement in the Republic of Srpska.

The Rulebook can be downloaded here.

The first series of seminars with subject “The Importance and Role of Mental Health Centres within DZ” was organised in December 2010 in three regional centres (Istocno Sarajevo, Teslic and Banja Luka) with participation of representatives of mental health centres, primary health centres, social welfare centres and psychiatric clinics. The second series of seminars, that gathered the same participants, was organised in June 2011 in Banja Luka, Trebinje and Teslic.

The third series of seminars organized by ASKVA will be held on November 9, 2011 at the San Hotel in Laktasi and on November 14, 2011 at the Kardial Hotel in Teslic. The participants will have an opportunity to listen to lectures on psychosomatic consequences of psychiatric disorders, experiences on implementation of the RS Development Strategy on Mental Health Care, activities of centre for social welfare in the field of comprehensive care of patients with mental disorders, as well as to recall all previous Agency’s activities on this project.

Following the signing of the Memorandum of Understanding and Cooperation in the health sector between the RS Ministry of Health and Social Welfare and the Ministry of Health of Republic of Serbia, signed by the RS Minister of Health and Social Welfare Prof. Dr Ranko Skrbic and the Serbian Minister of Health Prof. Dr Zoran Stankovic in Belgrade on August 23, 2011, Republic of Srpska and Republic of Serbia are strengthening the cooperation in the field of health.

The RS Agency for Certification, Accreditation and Health Care Improvement and the Agency for Accreditation of Health Care Institutions of Serbia have signed the Memorandum of Understanding and Cooperation that regulates the frame of cooperation in the field of health care quality improvement and accreditation system of health care institutions, promoting the current informal cooperation. This agreement provides introduction and further strengthening of the cooperation in the field of harmonising accreditation standards and methodology of health care institution auditing, in the field of auditors' exchange and training and joint accreditation audits, on the activities of exchange and cooperation on development of application for monitoring and reporting health care quality indicators, as well as on other activities that are in accordance with both institutions' primary activities.

The Memorandum of Understanding and Cooperation was signed on September 29, 2011 at the RS Government offices by, on behave of the RS Agency for Certification, Accreditation and Health Care Improvement, director Sinisa Stevic, Msc, MD and, on behave of the Agency for Accreditation health Care institution of Serbia, director Snezana Manic, MD.

The last, August issue of the magazine "Medici.com" published an article written by Oleg Grubac MD of CMZ Bijeljina on PMH seminars organized by the Agency in June 2011. We bring the entire article.

The second series of seminars organized by the RS Agency for Certification, Accreditation and Health Care Improvement (ASKVA), as a part of achieving the specific PMH goal C1 jointly implemented by entities' ministries of health in cooperation with the Swiss Government and the Swiss Agency for Development in the next three years was held in the second part of June 2011. This Project’s goal is related to improvement of understanding of managers of primary health centres (PHC), that have community mental health centres (CMHC) within their organisational structure, as well as to improvement of cooperation between CMHCs with other PHC medical services and other public services in communities they work in. That is the reason the seminars are named “The Importance and Role of Mental Health Centres within Primary Health Centres“ and are organised in series in regional centres. The first series of seminars were organized at the end of 2010, when participants, with other contents, had fill in the questionnaire that was used as a base for the research and creation of other specific needs of participants and the project program.

Like the previous series of seminars, in this educational-interactive cycle participants were PHCs’ managers, heads of CMHCs, hospital wards and clinics in Republic of Srpska together with managers of Centres for Social Welfare. During the one-day seminar held in Banja Luka, Trebinje and Teslic, the participants have been presented with results of the research (Dr sci. S. Dusanic) and good practice examples in CMHC accreditation processes (Brcko and Bijeljina) and developing a model of successful cooperation with other relevant subjects (Doboj) while Prof. M. Munjiza from Belgrade held an expert lecture from social psychiatry on the place and role of CMHC. As before, the participants while working in groups had a specific task: based on given model, to create their forms of memorandums of understanding and cooperation as practice of future particular use of knowledge learnt on these trainings. While presenting the results of group work, the participants had an opportunity to present their positive examples of this kind of cooperation with communities. In the non-formal part of the seminars, organized after the official program, the participants once again had an opportunity to acquaint each other better and exchange experiences.

This time too, ASKVA provided us with well-organized and –prepared, pragmatic and useful information as well as concrete possibilities of their appliance in our future development of cooperation with all public services in our communities, aiming to do further quality improvement of services we provide to visitors and beneficiaries of CMHC through multidisciplinary approach to community mental health care, already established and implemented model in our country. The third series of seminars continues in September 2011.

Written by:

Oleg Grubac MD, CMHC Bijeljina

The first series of seminars with subject “The Importance and Role of Mental Health Centres within DZ” was organised in December 2010 in three regional centres (Istocno Sarajevo, Teslic and Banja Luka) with participation of representatives of mental health centres, primary health centres, social welfare centres and psychiatric clinics. An initial research with specially designed questionnaire to meet the Project need was done during the seminar and will be used to create further project program.

The next series of seminars will be organised on June 17, 2011 in Banja Luka, June 21, 2011 in Trebinje and June 27, 2011 in Teslic. Based on the report on the initial research and its recommendations on following activities, a program of this series will include a presentation of the initial research report, presentation of examples of good practice of mental health centre’s work and intra- and inter-sector cooperation with other DZ medical services and institutions as well as a lecture on mental health care state in the Republic of Srpska and different mental illnesses. The participants will form working groups and practically work on creating cooperation protocols based on already successfully applied protocols.

Both sides have, by signing a contract on cooperation, agreed on developing relations based on mutual aid and cooperation in order to monitor diagnostic related groups (DRG), quality indicators and clinical pathways.

In order to monitor quality and safety indicators in RS hospitals, ASKVA has developed an on-line application to collect data necessary to calculate defined quality indicators (the application).

By implementing the hospital payment system based on DRG in April 2011, the Fund recognized possibility of cooperation with ASKVA. By creating small adjustments, the application could be used to collect data on DRG of every hospitalized patient. The application is already available and used by all hospitals, and that supported the idea.

Since April 2011, the application is used for collecting the DRG data of all hospitalized patients as well, in the following RS hospitals: Clinical Centre Banja Luka, GH Gradiska, GH Prijedor, GH Bijeljina, GH Doboj, GH Trebinje, GH Nevesinje, GH Zvornik, GH Foca, GH Kasindo and Institute for Physical Medicine and Rehabilitation “Dr Miroslav Zotovic”. The application is accessed through the ASKVA web site.

The course is organized in a way to provide knowledge and skills necessary to audit Quality Management System (QMS) in accordance with ISO 9001. The course completely fulfils criteria set by the International Register of Certified Auditors (IRCA – <link http: www.irca.org>www.irca.org). During the four and a half day long course, participants have prepared theoretically and practically to perform an audit of QMS of any company that set a goal to be ISO 9001 certified.

ISO 9001:2008 QMS specifies requirements that can be used for evaluation of organisation’s ability to satisfy customers and applicable laws and regulations. The Standard is directed to meet customers’ needs and is the only document used to do third party audit or certification.

The instructor of the outstanding course was Milan Ivanovic, director of Lloyd’s Register doo Belgrade. All course participants have been issued a participation certificate and those who successfully passed the course final exam have been awarded with a certificate.

Organising this course is a part of initial preparations that ASKVA take in order to, as soon as possible, undergo ISO 9001 auditing of the Agency’s QMS.

The conference’s welcoming speech was given by Nevena Karanovic MD, state secretary of Serbian Ministry of Health and Yolanda San Jose, head of operations I, delegation of the European Union to the Republic of Serbia. Main speakers at the conference were Snezana Manic MD, director of the Agency of Accreditation of Health Care Institutions of Serbia and Annette Katrava, team leader/health accreditation expert who jointly presented accomplishments of the Project and the Agency. 

The conference was attended by representatives of Serbian primary health care centres, hospitals and other state and private health care institutions.

The international guests at the conference were accreditation experts from Slovenia (Biserka Simcic), Hungary (Akos Peter Mayer MD), the Republic of Srpska (Sinisa Stevic MD) and Italy (Andrea Gardini MD). The ASKVA director Sinisa Stevic presented the accreditation program in the Republic of Srpska through presentation “Health Care Quality and Accreditation in Republic of Srpska”.

The project’s main purpose was to support the initial activities in development of the Agency for Accreditation of the Health Care Institutions of Serbia (AZUS) so that appropriate institutional, organizational and management arrangements as well as system capacities are in place in order to perform accreditation program in Serbia in a competent and self-sustainable manner. The objectives of Accreditation are improvement of health care quality and patient safety and establishment of trust of health care service users in health care system.

The European Union has secured 1,5 million EUR from the IPA financial instrument for Serbia for the 22 months long project “Establishment of the Public Agency for Accreditation and Continuous Quality Improvement of Health Care in Serbia“.

We are very pleased to inform you that, after thorough preparations of teams of Mental Health Center (CMZ) Bijeljina in Primary Health Care Center (DZ) Bijeljina, as well as fulfilling all formal and legal aspect defined by the RS Rulebook on Accreditation of Health Care Institutions, accreditation program of this CMZ has been conducted.

Thanks to the agility of Zlatko Maksimovic MD, DZ director, and team of his associates who recognized the importance of accreditation in health care quality system, as well as high motivation of CMZ employees themselves, CMZ implemented extremely quality preparations and the accreditation audit took place on February 25, 2011.

The ASKVA team of registered auditors who work with CMZ Doboj and Brcko conducted the audit. The whole process of preparations and audit procedure were excellently organized and hosts were very kind.

The auditors conducted the process by interviewing teams’ members, examination of medical documentations, working environment and equipment and by surveying patients. After the audit, the auditors submitted a written report to the Agency that stated that CMZ Bijeljina achieved high level of quality and we sincerely congratulate them. According to the afore mentioned report, the Accreditation Commission, on the meeting held on March 4, 2011, adopted a decision on awarding CMZ Bijeljina with accreditation status.

On this occasion, the Agency for Certification, Accreditation and Health Care Improvement of the Republic of Srpska would like to thank all employees of CMZ Bijeljina and management of DZ on all efforts they made and ask them to keep on working together on quality improvement of health care in Republic of Srpska.